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General NPI Number Information
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NPI Number | 1780901330
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Entity Type | Organization
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Legal Business Name | BRUNSWICK PHYSICAL THERAPY AND REHABILITATION LLC
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 725 RIVER RD SUITE 32-253
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-951-7534
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Fax | 201-758-5095
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Provider Business Mailing Address
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Address Line | 725 RIVER RD SUITE 32-253
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-951-7534
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Fax | 201-758-5095
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDILBERTO ORCULLO ESTOMO JR.
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Credential | PHYSICAL THERAPIST
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Telephone | 201-951-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251H1300X
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Taxonomy Name | Human Factors Physical Therapist
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License Number | 40QA00520400
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License Number State | NJ
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